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Experience of diet in patients with inflammatory bowel disease: A thematic synthesis of qualitative studies

Abstract

Aim

To synthesise the dietary expesriences of patients with inflammatory bowel disease by reviewing relevant qualitative studies.

Background

Diet plays a crucial role in the development and progression of inflammatory bowel disease (IBD). There is no specific diet that can be recommended for all patients. We conducted a synthesis of qualitative studies to gain a comprehensive understanding of the dietary management experience of patients with IBD, aiming to provide better dietary guidance in the future.

Design

A qualitative synthesis was conducted following the Thomas and Harden method and reported following the ENTREQ statement.

Methods

Qualitative studies were systematically searched in five electronic databases: PubMed, PsycINFO, Embase, CINAHL, and Web of Science. There was no time limit for publication, and all database searches were up to 10 May, 2023. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was utilised to appraise the quality of the included studies. Data for inclusion in articles were extracted and analysed using a thematic synthesis method.

Results

Six studies involving 119 patients were eventually included. The studies were conducted in six different countries. Four major themes were identified: the diet of patients with IBD is completely different from the normal one; manage symptoms and live with the disease by modifying diet; psychological adjustment to eating (be frustrated; worried and afraid; feel ashamed; growth and resilience); barriers and challenges (barriers from perceived social support; conflicts between diet and nutrition; challenges from food hedonism and cravings).

Conclusions

Patients with IBD highlighted the distinction between their diet and the normal diet. Dietary modifications were used as a way to manage symptoms and live with the disease. In addition to physical symptoms, patients experienced diet-related psychological changes. Dietary modifications in patients with IBD encounters difficulties and challenges, necessitating prompt guidance and intervention.

(1) The implementation of dietary modifications in patients with IBD encounters numerous obstacles and complexities, necessitating prompt guidance and intervention.

Patient or Public Contribution

No patient or public contribution.

Registration

The protocol was registered with PROSPERO (CRD42023391545).

Experience and caring needs of patients with psoriasis: A qualitative meta‐synthesis

Abstract

Background

As a chronic skin disease, psoriasis often affects the physical, psychological and social status of the patient, which in turn impacts on their experience of illness and needs. However, there is no review of qualitative research that integrates and analyses the experiences and needs of these three influences from a holistic perspective.

Methods

This review follows the ENTREQ guidelines. Six English databases (JBI, Cochrane Library, PubMed, PsyINFO, CINAHL and Embase) and three Chinese databases (CNKI, VIP and Wanfang) were searched from January 2012 to October 2022. Literature was included if it was relevant to the experience of illness and caring needs of patients with psoriasis. The JBI-QARI was used to rate the quality of included studies.

Results

Eleven studies were included in the meta-synthesis. Four analytical themes were identified for analysis: physical challenges, psychological discomfort, social phenomena and caring needs.

Conclusions

The combined physical, psychological and social effects of psoriasis and the consequent caring needs should be emphasised. Health professionals, including doctors and nurses, should be aware of the multiple changes in patients and their coping strategies, provide information about psoriasis, monitor and follow-up regularly over time and obtain feedback to inform further treatment and care so as to develop high-quality therapeutic interventions to help and guide patients with their coping strategies.

Relevance to Clinical Practice

These findings describe the physical, psychological and social experiences of illness and caring needs of patients with psoriasis. Healthcare professionals should be more aware of patients' easily overlooked psychological and social distress, providing prompt attention and recognition of patients' experiences and needs, offering relevant assistance and support and enhancing daily, regular follow-up to help them improve their understanding of and ability to manage their illness.

No Patient or Public Contribution

This is a meta-synthesis without direct patient involvement.

Factors impeding physical activity in older hospitalised patients: A qualitative meta‐synthesis

Abstract

Background

Older hospitalised patients have low levels of physical activity and multiple impairing factors.

Aims

To systematically evaluate the perceived barriers to physical activity among older patients during hospitalisation, and provide reference for future intervention programs.

Design

Following ENTREQ, do a systematic evaluation and synthesis of qualitative investigations.

Methods

An exhaustive exploration was conducted across the CNKI, Wanfang Database, VIP Database, China Biomedical Literature Database, PubMed, Embase, Cochrane Library and Web of Science from their inception until August, 2023 to identify qualitative research on obstacles to physical activity among older hospital patients. The quality of the literature was evaluated using the Joanna Briggs Institute's critical appraisal tool for qualitative research. Meta-synthesis method was used to integrate the results.

Results

In total, 8 literatures were included, 43 themes were extracted, and analogous research results were amalgamated to generate 10 categories and 3 syntheses: individual level, interpersonal influencing factors and hospital environment and resources level.

Conclusion

Older inpatients are faced with multiple barriers to physical activity. Medical staff should pay attention to changes in physical activity during hospitalisation, identify barriers to physical activity in older inpatients and provide references for promoting physical activity programs for the older.

No Patient or Public Contribution

This study is a meta-synthesis and does not require relevant contributions from patients or the public.

What is already known

Older patients are at low physical activity levels during hospitalisation. Older inpatients are faced with multiple barriers to physical activity.

What this paper adds

Factors of physical activity impairment in hospitalised older patients should be considered in the context of health status, psychological factors, motivation and social support. Disease-induced psychological fallout has a greater impact on physical activity in the older.

Influencing factors of inter‐nursing lateral violence: A qualitative systematic review

Abstract

Background

Lateral violence is a global social problem that has attracted considerable attention in the field of public health. This has seriously affected the quality of care, the safety of patients' lives and the career development of nurses.

Objective

To systematically evaluate the factors influencing of nursing lateral violence and provide evidence for preventing and reducing inter-nursing lateral violence.

Methods

A systematic review of qualitative study was performed in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. We collected qualitative studies on the factors influencing of inter-nursing lateral violence by searching PubMed, EMbase, The Cochrane Library, Web of Science, CINAHL, Science Direct, WanFang Data, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP) and Chinese Biomedical Literature Database (CBM). Data from inception to September 2023. Literature screening and data extraction were independently conducted by two reviewers. The Critical Appraisal Skills Program (CASP) scale was employed to assess the quality of the studies, including objectives, methodologies, designs, results and contributions.

Results

A total of 25 studies involving 882 participants were included. The results of the thematic analysis indicated that inter-nursing lateral violence was influenced by hospital management, perpetrators, victims and sociodemographic factors.

Conclusion

Inter-nursing lateral violence was influenced by multidimensional factors. To reduce the occurrence of horizontal violence among nurses, hospitals need to explore the establishment and improvement of a horizontal violence resolution mechanism, and schools should pay attention to the joint support and education of nursing students, create a good working environment and harmonious nursing culture, and promote mutual respect among nurses.

Relevance to Clinical Practice

This review emphasises the importance of the influencing factors of horizontal violence among nurses, analyses the importance of influencing factors from different perspectives, and proposes corresponding measures to reduce inter-nursing lateral violence.

No Patient or Public Contribution

This study was mostly a literature review; neither patients nor pertinent staff were involved in either the design or conduct of the investigation.

Navigating tensions when life‐sustaining treatment is withdrawn: A thematic synthesis of nurses' and physicians' experiences

Abstract

Aim

To synthesise nurses' and physicians' experiences with withdrawing life-sustaining treatment in an intensive care unit.

Design

The chosen methodology is thematic synthesis. The Preferred Reporting Items for Systematic Review and Meta-Analyses and Enhancing Transparency are used in Reporting the Synthesis of Qualitative Research Statement.

Methods and Data Sources

A systematic search is conducted in APA PsycINFO, CINAHL Plus, EMBASE, PubMed and Web of Science following the inclusion and exclusion criteria in April 2023. Two reviewers independently screened and extracted the qualitative data. Subsequently, data analysis was conducted using thematic analysis of qualitative research. This study was not registered with any review registry due to the irrelevance of the data to health-related outcomes.

Results

From the 16 articles, 267 quotes were extracted and analysed. The findings of the study revealed five analytical themes: (1) tensions between interdependent collaboration and hierarchical roles; (2) tensions between dignified dying or therapeutic perspectives; (3) family members' reflections of patient's wishes; (4) tensions in family members' positions; and (5) double-sidedness of distress.

Conclusion

This study contributes to nursing knowledge by providing a more nuanced understanding of this complex phenomenon of withdrawing life-sustaining treatment. The findings of this study have revealed significant variations globally in the practices surrounding the withdrawal of life-sustaining treatment in intensive care units, emphasising the need for further research to inform clinical practices that cater to diverse contexts.

Reporting Method

Enhancing Transparency are used in Reporting the Synthesis of Qualitative Research Statement (ENTREQ statement).

Patient or Public Contribution

Since this study reported a potential collision between the patient's dignified dying and the family member's perceptions and interests, the family member's wishes should be carefully distinguished from the patient's quality of end of life in practice.

A meta‐synthesis of the experience of paediatric nurses in communication with children

Abstract

Aim

This study aimed to conduct a meta-synthesis to explore the experiences of paediatric nurses in communication with children.

Method

We conducted a meta-synthesis review, following the outline proposed by Sandelowski, Barrosso & Voils. Our search encompassed six electronic databases, namely PubMed, Scopus, EBSCO (MEDLINE), Web of Science, SAGE, and Wiley. The Primary keywords used were “nurse”, “child”, “communication”, and “qualitative”. We included qualitative articles in English within the field of paediatric nursing between 1990 and 2023. Initially, 1980 records were identified which reduced to 1339 references after removing duplicates. Subsequently, we assessed 112 full-text articles for eligibility and 14 relevant studies were ultimately included in our review. Quality appraisal was conducted using the Critical Appraisal Skill Programme checklist with no study being excluded based on quality criteria. Data were synthesized using the qualitative thematic analysis method.

Results

The data analysis yielded three themes and seven sub-themes. These themes include swinging between triadic and dyadic communication, applying a hybrid of communication methods, and influential factor in communication.

Conclusions

This study highlighted the significance of establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse–parent–child) in paediatric care. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Additionally, identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments.

Implications

Understanding the communication process and the factors that influence it can be instrumental in equipping paediatric nurses with enhanced communication skills in their practice.

Impact

Establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse–parent–child) in paediatric care is crucial. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments.

Exploring intensive care nurses' perception of simulation‐based learning: A systematic review and meta‐synthesis

Abstract

Aim(s)

To explore intensive care nurses' (ICN) perceptions of simulation-based learning (SBL).

Design

A systematic review and meta-synthesis.

Methods

The review followed the PRISMA guidelines for reporting a systematic review. A systematic search strategy was developed using a modified PICo framework. A comprehensive search was conducted in July 2023 in CINAHL, OVID Embase, Medline complete, Web of Science, ERIC and Scopus databases for articles published in English between 2013 and 2023. Data were extracted using the Joanna Briggs Institute QARI Data Extraction, with data synthesis guided by Braun and Clark's thematic analysis approach. Quality appraisal was assessed using the CASP tool.

Results

Eleven studies providing qualitative data were included for analysis. Analysis and meta-synthesis led to the construction of two themes: The learning experience and professional growth through collaboration.

Conclusion

The review highlights the balance needed in finding the appropriate simulation approach, with the right level of fidelity, conducted at appropriately regular intervals, incorporating the correct makeup of professional team members, conducted in the right environment and facilitated by a skilled facilitator, to ensure best outcomes and return on investment for ICN's education.

Implications for Practice

These findings are a valuable resource for educators and organisations considering simulation-based learning initiatives in the intensive care setting.

No Patient or Public Contribution

This review involved analysis of existing literature and as such no unique patient or public involvement occurred.

Reporting Method

The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines.

Balancing on life's ladder: A meta‐ethnography of the existential experiences of siblings of children with complex care needs

Abstract

Aim

To synthesize and interpret existing qualitative research on the existential experiences of siblings of children with complex care needs.

Design

Noblit and Hare's interpretive meta-ethnography.

Methods

The study has been registered in the international prospective register for systematic reviews (PROSPERO). Noblit and Hare's 7-step procedure was followed and reciprocal translation was performed to analyse the data and develop a line of argument synthesis.

Data Sources

A comprehensive systematic literature search of five databases, along with extensive manual searches, was completed in November 2022. The final sample comprised 18 studies published between 2010 and 2022.

Results

A line of argument, expressed through an overarching metaphor, “balancing on life's ladder”, illustrates the core findings of siblings' fluctuating experiences of existential well-being, and encapsulates four third-order themes: the emotional turmoil of siblings, interrupted family life, siblings strive to be themselves and siblings struggle to cope.

Conclusion

Growing up with a sibling with complex care needs made children feel invisible, lonely and struggling to find the courage to cope. By adopting a lifeworld approach, nurses can become aware of healthy siblings' unmet needs. Future research is needed on how nurses can contribute to siblings' existential well-being, in primary – and secondary health care settings.

Implications

The study provides insight into siblings' existential experiences and factors improving their well-being, enabling nurses to provide a more optimized lifeworld-led clinical practice.

Impact

Healthcare, nursing education and practice should be informed by the knowledge of existential issues. Nurses are well-positioned to work alongside families to provide family-centered care. Our findings have implications for health policies tailored to the needs of children with chronically ill siblings.

Reporting Method

This review adheres to the Equator and improving reporting of meta-ethnography (eMERGe) guidelines.

Patient or Public Contribution

No patient or public contribution, because the data comprised previously published studies.

A meta‐synthesis exploring nurses' experiences of assisted dying and participation decision‐making

Abstract

Aims and Objectives

To explore nurses' experiences of assisted dying and understand how their perspectives inform their participation decision-making.

Background

Assisted dying is a complex and contentious issue with the potential to create moral unrest for nurses. The nursing role in assisted dying varies between jurisdictions.

Design

Systematic review. A meta-synthesis using thematic analysis.

Methods

Three electronic databases were searched for primary qualitative studies published in English, from New Zealand, Australia or Canada, up to October 2022. Seven articles were included; themes were analysed and key themes were established. Reporting adhered to PRISMA.

Results

The findings highlight the complexity of nurses' decision-making about participation or non-participation in assisted dying and the moral, philosophical and social influences that impact on their decision-making. This is presented as a spectrum of influence which persuades or dissuades nurses to participate in assisted dying. The 12 themes have been categorised into four key themes: personal persuaders, personal dissuaders, professional persuaders and professional dissuaders.

Conclusions

The findings suggest that nurses should be involved in policy and procedure guideline development and be offered education and training programmes to ensure safe, confident and informed practice. The need for mentorship programmes was also prevalent in the research.

Relevance to Clinical Practice

It is crucial that nurses be offered education and training in assisted dying. Clear policy and procedure guidelines are essential, and nurses should be involved in the development of these.

Student nurses' experiences of remote learning during Covid‐19 pandemic: A qualitative evidence synthesis

Abstract

Aim

To systematically synthesize undergraduate student nurses' experience of online, blended or distance learning during Covid-19 pandemic.

Design

A qualitative evidence synthesis (QES).

Review Methods

A QES. Themes were organized using the ‘best fit’ framework approach. Methodological limitations and confidence in the review findings were informed by GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research).

Data Sources

Qualitative literature from five databases including CINAHL, PubMed, Medline, Education Full Text (H.W. Wilson) and ERIC were searched from March 2020 to November 2021.

Results

Nine qualitative and two mixed method studies were included in this ‘best fit’ framework using Chickering and Gamson's Seven Principles for Good Practice in Undergraduate Education. Importance of the social presence of the teacher through effective communication and interpersonal relationships is highlighted. Clinical placement and in-person practical skills training are needed for effective nursing education.

Conclusions

This review highlighted that online content can be developed into efficient and high-quality learner-centred education within blended undergraduate nursing programmes incorporating essential face-to-face and practical components. Various supporting measures are required for both students and faculty. We suggest an adaptation of a ‘Blending with Purpose: The Multimodal Model’ with key considerations for undergraduate nursing programmes where pedagogical objectives and activities drive the approaches to achieve intended learning outcomes and student satisfaction.

Implications for the Profession

Well-designed online programmes using digital tools that support interaction and teamwork are required for undergraduate nursing education.

Impact

Blended learning approaches offer more flexibility than online learning alone which leads to improved student engagement. Clinical placement and in-person practical skills training are needed for effective nursing education.

Reporting Method

‘Enhancing transparency in reporting the synthesis of qualitative research’ (ENTREQ) for QES.

No Patient or Public Contribution

No Patient or Public Contribution.

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